Revenue Management - Medicare

Revenue Management - Medicare

The healthcare payment market is well-established, with a sequence of steps and standards for the submission and payment of claims. On account of the fact that the healthcare is rapidly evolving under the direction of the Affordable Care Act (ACA), businesses, health plans, and federal segments are all facing new challenges. By implementing practice management systems, providers can submit claims using a clearinghouse, which then transfers those claims to payers. The payers then resolve claims for payment, send them back to be resubmitted, or reject them.

As you are already aware, most of the current payment process results from legacy system restrictions. The extensive use of electronic claim standards and developments in technology enables claims to be scrutinized and information shared through payer portals, practice management systems, or clearinghouse gateways in real-time.

How to improve payment process with technology

Presently, as claims pass get routed through the clearinghouse or claims gateway, they move through HIPAA, duplicate checks, and eligibility logic. Our rules engines can now relate to extra level of checks to certify compliance along with coding standards and any particular provider contracts with that payer.Through this technology, any and all information related with these coding and compliance checks are made accessible to payer and provider staff to ensure online access to all participants. Executing this level of checks prior to negotiation serves both payers and providers.

Role of Plato Technologies in improving revenue management in medicare

Plato Technologies serves as a center for Medicare and Medicaid Services. With over 17 years of experience in the healthcare industry, Plato Technologies is regarded as a forerunner in providing a wide range of Medicare Support Services with a negligible turnaround. Our vigorous and cost-effective solutions cater to the needs of the medicare advantage and prescription drug (MA-PD) market. Our profound subject matter expertise and domain knowledge in the MA-PD market has enabled us to ensure that our clients remain 100% compliant.

Currently, we cater to the needs of several health plans in the USA using our software platform. Our diverse range of services includes:

  • Revenue Management
  • Appeals & Grievances
  • Member Eligibility Verification
  • Coordination of Benefits (COB)
  • Member Enrollment and Application Processing
  • Payment Reconciliation
  • Member Management
  • Demographic Reconciliation
  • Premium Billing
  • Encounter Data Processing

Plato Technologies healthcare solutions for managing HCC revenue help you to effectively improve the accuracy of risk-adjusted payments. Following are the striking features of our medicare solutions:

  • Allows you to evaluate the morbidity level of each member, based on claims and pharmacy data.

  • Estimates risk scores for members and determine the additional HCCs suspected or confirmed that potentially impacts revenue.

  • Detects those providers and members who require risk adjustment.

  • Compares the coding to regulate the risk-adjusted payments generated from the CMS for accuracy.

  • Generates reports that help you prepare support documents for audits.

By enabling efficiencies corresponding to the current and anticipated trends, Plato Technologies helps enterprises perform better. We bring expertise, customer service, best practices, innovation, and exceptional staff to deliver quality, efficiency and agility to our clients.

Thus, we help our customers gain an end-to-end solution for all payment and reconciliation facets of Medicare. Our solutions are built focusing the CMS calendar and optimize the intimate familiarity of our professional staff. Furthermore, we possess the capability to work with federal and state regulations and transform them into complete enterprise practices.